Whether treating suspected skin cancers, sun damaged skin, acne or acne rosacea the process is very similar. This treatment utilizes a drug called Levulan ALA, and a light source. Levulan ALA is applied topically (directly to the skin) and on any lesions that are of concern. A light or laser source is then used to activate the Levulan ALA and the targeted cells are destroyed.
What is Levulan ALA ?
Levulan (20% aminolevulinic acid-ALA) is a clear solution which is applied to the freshly cleansed skin. ALA occurs naturally in the body and is involved in heme synthesis. The skin absorbs the ALA and converts it to a natural photo sensitizer called Protoporphryn. After being left on the skin for 30-60 minutes the ALA is ‘turned on’ by a light or laser source. This causes singlet oxygen production. The release of singlet oxygen causes the destruction of the target cell membrane and the cell in question.
Does Treatment Hurt?
No. Most patients do report a mild stinging on their skin during treatment.
How Much Improvement Can I expect?
Patients with severe sun damaged skin manifested by Actinic Keratosis, texture and tone changes, mottled pigmentation and skin laxity may see excellent results. Patients may also see improvement of large pores and pitted acne scars… Active acne and acne rosacea can improve dramatically.
How Many treatments will it take to see the best Results?
To achieve maximum improvement of precancerous lesions (AKs), sun damage, tone and texture changes, and acne and acne rosacea, a series of 3-5 treatments 2-4 weeks apart is the most effective regime. More treatments may be done at future intervals to maintain the rejuvenated appearance of the skin.
What are the Advantages of Photodynamic Therapy?
- Easier for patients than repeated topical liquid nitrogen, Efudex (5 fu), or Aldara because side effects are minimal, rapid healing, and only 3-5 treatments required.
- The ALA treatment is painless compared to liquid nitrogen, 5-FU and Aldara.
- Reduced scarring and improved cosmetic outcome compared with cautery, surgery and Efudex. Liquid nitrogen can leave white spots on your skin.
- Levulan improves the whole facial area treated, creating all one color, texture, and tone rather than just spot treating with liquid nitrogen, cautery and surgery. In summary, PDT matches the “Ideal treatment “for photo damaged skin:
- well tolerated (essentially painless)
- easily performed by a specialty clinic environment
- non invasive (no needles or surgery required)
- Excellent cosmetic outcome.
What are the disadvantages?
Following Photodynamic therapy, the treated areas can appear red with some peeling for 2-7 days. Some patients have an exuhuberant response to PDT, and experience marked redness of their skin. Temporary swelling of the lips and around the eyes can occur for a few days. Darker pigmented patches called liver spots can become temporarily darker and then peel off leaving normal skin. (This usually occurs over 7-10 days). Repeat treatments may be necessary as PDT is not an exact science.
Are There any Contraindications to Levulan/Photodynamic Therapy?
- Anyone suffering from Porphyria or who has a known allergy to Porphyrins.
- Anyone Taking any of the Following Medications:
- Griseofulvin (Fulvicin-Antifungal/Antibiotic)
- Thiazide Diuretics (Lozide/Hydrochlorathiazide/Zaroxolyn/Moduret/Diazide)
- Sulfonoylureas (Diabeta/Diamicron/Glyburide)
- Phenothiazines (Largactil/Chlorpromazine/Perphenazine/Mellaril/Nozinan)
- Sulfonamides (Pediazole/Septra/Sulfa)
These medications may increase the photosensitivity reaction.
3. If you are treated with Levulan, you should avoid sun exposure and bright lights for 40 hours. Sunscreens will not work.
What should I expect after Treatment with Levulan/Photodynamic Therapy?
- Mild stinging and burning will occur during treatment
- Following treatment the area and surrounding skin will redden.
- Swelling and hypo/hyper pigmentation may occur
- You may also see scaling, itching, crusting and changes in skin colour
- These changes should reach a maximum the day after treatment, should improve markedly by the end of the first week and should be completely resolved by 4 weeks after treatment.
- It is important to note that although there will be some stinging; most patients tolerate the procedure well.